Chronic CO Poisoning:

Lumio Chronic Carbon Monoxide Study:

Webmaster's Note: This is a wonderful epidemiologic study of certain aspects of chronic CO poisoning that came out of the necessities of World War II. It has unfortunately been under-appreciated, but its implications for present day CO toxicology are profound.

1. Short Review of the Origin and Development of the Carbon Monoxide Poisoning Problem in the Northern Countries (Scandinavia).

War always upsets social life and its development how the
various forms and interests of the different social classes are not
affected to the same extent. Thus we find fields of life in which
work continues almost normally through war-time even, whereas in
other fields everything must be adapted to meet the needs of war.
Medical science is a branch which must either directly or indirectly
completely serve the purposes of war, and repeatedly solve problems occasioned by it.

War effects medical science in two different ways: first directly, by injuring and causing the loss of human lives and thus compelling
military surgeons to save as many as possible from destruction.
The more the development of history draws the home front into
the war zone, the more the problem requires attention. Second war
effects the work of the medical profession indirectly by isolating
the countries engaged in war from their markets and by sending
most of the produce of the country for the army to utilize. This
causes a shortage of all kinds of materials. The tendency to replace
genuine materials with surrogates is a natural result of the prevailing conditions. Characteristic of the surrogates is that they are incapable of competing with the genuine material. However, one
important requirement set upon them is that they are not dangerous
to health. Numerous surrogates cause, namely, diseases belonging to
every medical branch with which the medical profession must
acquaint itself, both during war as well as during the shortage
following it.

In the latest war and immediately after it, surrogate industry
produced numerous materials many of which proved to be dangerous to health. As the post-war social aim was to fix special attention upon hygienic conditions under which industrial workers laboured, war furthered in this way the decisive investigation of industrial diseases.

The shortage of petrol (gasoline) became an important question of everyday life. It was, already during peacetime, used abundantly
in certain industrial branches without being considered a surrogate.
However, as liquid fuel during war was difficultly available, many
countries were forced to replace it with something else. The northern countries, which in times of need were accustomed to resort to wood, began to use carbon monoxide for motor car power and consequently CO generators. The hygienic dangers of these motors were soon realized and they gave rise to an altogether new social problem - the CO problem. Two different reasons caused it: first, the class of people affected by the gas was an altogether new and vast one; second, almost every person experienced what it means to be involved in the danger of CO when driving in a crowded motor car provided with a CO generator. This background in view one can readily understand the strong reaction of the northern countries against CO.

Sweden, the only northern country, which succeeded in remaining
out of war had the best investigators and financial possibilities to solve the problem. Thus, already in thc autumn of 1939, i.e.
immediately after thc outbreak of war, attention was paid to the
danger which in the form of CO menaced people. A special board was appointed on September 6, 1939 to investigate the problem and to take care of the technical control and prophylaxis thereof. The social medical side of the question was not studied until a board was appointed on December 30, 1940 to investigate this side of the problem also. This board named a special committee and set up a laboratory for determining the COHb of blood. A special CO clinic was founded in thc Sabbatsberg hospital in April, 1941. Uppsala and Orebro got their clinics a little later.

A CO clinic was founded in the Karolinska Sjukhuset in 1945, hence after the supply of CO had decreased to great deal. A law, which provided that chronic CO poisoning was to be held as an occupational disease which is indemnified, was also enacted. In Sweden a considerable number of workers employed in different lines of occupation came into contact with CO. In 1942, namely, 250,000 persons worked under its influence and over 100,000 automobiles provided with a CO generator were in use. For this reason CO poisoning became the most common occupational disease in the country. The largest number (226 cases) of acute diseases were cared for in 1942, while the most chronic diseases (1,948 cases) appeared 1944 (Salen, 1946). The clinical picture of CO poisoning and the factors causing it became gradually evident to the medical profession and to the public also through numerous investigations published on the matter. The CO investigation did not, however, win the unanimous approval of the physicians and polemic caused by it did not subside until peace came and liquid fuel was again available.

The CO problem was not as important a social problem in Norway and Denmark. The number of motor cars having CO generators in Denmark rose only to 24,000, so no special CO clinic was considered necessary. However, investigation among the automobile drivers in Copenhagen were conducted in 1943 - 1944 in order to obtain knowledge concerning the CO poisoning cases (Grut, 1946).

In Finland, on the contrary, CO played a considerably more important role than in Sweden. Practically all the motor cars in civilian use as well as later on the ones used by the army, were provided with CO generators. In practice the question could not be cared for in the best possible way: the largest part of the medical profession was engaged by the army and in addition, financial means for investigating the problem were lacking.

Already during the war, some physicians fully comprehended the prevalent drawbacks. In 1940 at the meeting of the Duodecim Society, Makela presented the dangers of CO in the army. In 1943 - 45, a large number of questionnaires were sent to automobile drivers in order to obtain knowledge concerning the distribution of CO poisoning in Finland. On this basis, a conclusion, that about 40 - 50% of the workers in this line had symptoms of chronic CO poisoning, was drawn (Noro, 1945-46).

Investigative and prophylactic work proper was not begun until after the war. A Clinic for Occupational Medicine, the object of which was to investigate the CO problem, was founded
in February 1945. On basis of the experiments made in Sweden and
the investigation results obtained in our own country, it proved
necessary to appoint consultant doctors from different medical branches to aid the said clinic. The Foundation of Occupational
Medicine was established to furnish financial support for the
investigation work. It received substantial aid from different
industries and the Red Cross of Finland. The examination results of
the Clinic provided the physicians with the following knowledge
of the disease: it is a chronic disease, which develops without
severe symptoms caused either by chronic CO or by
acute attacks of poisoning. Several authors have already published results of their investigations (Bagh, 1946; Helminen, 1945-46; Noro & Saksela, 1945-46; Siirala, 1946-48; Lumio, 1948; Sumari, 1946). This study treats the subject from an otological standpoint and belongs to the same series as the investigations of the authors mentioned herein above.